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A nurse surveys the medical records for violations of patients' rights. Which finding signals a violation?
- A. No treatment plan is present in record.
- B. Patient belongings were searched at admission.
- C. Physical restraints were used to prevent harm to self.
- D. Patient is placed on one-to-one continuous observation.
Correct Answer: A
Rationale: The patient has the right to have a treatment plan. Inspecting a patient's belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self that occur as a result of a mental disorder.
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A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a pre-discharge visit, the case manager learns the patient received a notice of eviction on the day of admission. What is the most appropriate intervention for the case manager to implement?
- A. Cancel the patient's discharge from the hospital.
- B. Contact the landlord who evicted the patient to discuss the situation.
- C. Arrange a temporary place for the patient to stay until new housing can be secured.
- D. Document that the patient's recovery will be hampered because of homelessness.
Correct Answer: C
Rationale: The case manager should intervene by arranging temporary shelter for the patient until suitable housing can be found. This is part of the coordination and delivery of services that falls under the case manager role. The other options are not viable alternatives.
A patient hurriedly tells the community mental health nurse, 'Everything's a disaster! I can't concentrate. My disability check didn't come. My roommate moved out, and I can't afford the rent. My therapist is moving away. I feel like I'm coming apart.' What should be the immediate focus of nursing care?
- A. Assisting with the clarification of personal values
- B. Helping the patient cope with feelings of abandonment
- C. Assisting with the management of anxiety that may lead to psychological disequilibrium
- D. Facilitating the clarification of the patient's misperceptions of the environment
Correct Answer: C
Rationale: Subjective and objective data suggest the patient is experiencing anxiety caused by multiple threats to security needs; therefore, interventions will focus on assisting the patient to cope with anxiety. While the patient may have feelings of abandonment, this is only one aspect of the anxiety. Data are not present to suggest the patient's personal values are unclear or that the patient is misperceiving the environment.
Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for a patient presenting with what characteristic?
- A. Presents a clear danger to self or others.
- B. Consistently noncompliant with medications at home.
- C. Has no reliable support systems in the local community.
- D. Develops new symptoms during the course of an illness.
Correct Answer: A
Rationale: Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The incorrect options do not necessarily describe patients for whom less restrictive treatment is indicated.
The following patients are seen in the emergency department. The psychiatric unit has one bed available. The patient demonstrating which problem should the admitting officer recommend for admission to the hospital?
- A. Experiencing dry mouth and tremor related to side effects of haloperidol
- B. Experiencing anxiety after divorcing a spouse after 10 years of marriage
- C. Has a self-inflicted a superficial cut on the forearm after a family argument
- D. Has begun hearing voices encouraging her to, 'Smother your infant'
Correct Answer: D
Rationale: Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.
A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, 'I feel the same.' Which intervention supports the nurse's assessment while preserving the patient's autonomy?
- A. Arrange for a short hospitalization.
- B. Schedule weekly clinic appointments.
- C. Refer the patient to the crisis intervention clinic.
- D. Call the family and ask them to observe the patient closely.
Correct Answer: B
Rationale: Scheduling clinic appointments at shorter intervals will give the opportunity for more frequent assessment of symptoms and allow the nurse to use early intervention. If the patient does not admit to having a crisis or problem, a referral would be useless. The remaining options may produce unreliable information, violate the patient's privacy, and waste scarce resources.